Extension to File - City of Xenia

CITY OF XENIA, OHIO
Income Tax Division
APPLICATION FOR EXTENSION OF TIME TO FILE
This application must be accompanied by a remittance of the net tax due, if any. An extension to file is not an
extension to pay. Estimated taxes due must be paid with the extension request to avoid additional penalties and
interest*.
For Calendar Year Ending December 31, _____________
or
For Fiscal Year Beginning and Ending ,
Account No.
Name
Address
City State Zip
File this form with the Division of Taxation, on or
before the due date of the return.
See instructions on second page.
Social Security Number(s)____________________
____________________
Fed. I D No.
*Non-payment penalty is 5% per month (or part thereof). Interest is 1.5% per month (or part thereof) compounded.
Estimated Total City Taxable Income
Estimated Tax Due @ 2.25%
Less Estimated Payments made previously, City Income Tax
Withholding Credits, and/or Prior Year Overpayments
Net Tax Due – Tentative Amounts
Payment that should be made with this Application for Extension
to File
$______________________
$______________________
$______________________
$______________________
$______________________
Do you wish to receive notification that your extension to file has been approved? If so, how do you wish to receive this notice?:
Email – send notice of approval to the following email address ____________________________________
Mail – a self-addressed stamped envelope must be provided.
An extension of six months for filing City Income Tax Return for the year stated above is hereby requested for the
following reason:
I declare that the extension requested herein for filing of the Xenia City Income Tax Return for the taxable year
stated is necessary for the reason given above and that I am authorized to sign this request.
_____________________________________________ OR ________________________________________
Signature (see instructions)
Email (in lieu of digital signature)
____________________________________________
Title
___________________________________
NO EXTENSION WILL BE GRANTED IF RECEIVED AFTER THE DUE DATE
Date
FOR OFFICE USE ONLY:
Approved? Yes ____ No ____
By________________ Date________________
Input? Yes ____ Date________________
Notification done? (if requested) Yes ____
Notification Date________________

GENERAL PROVISIONS
Upon written request of the taxpayer, made on or before the date for filing the return, the income tax administrator
may extend the time for filing such return for a period not to exceed six (6) months, or until the last day of the
month following the month of the due date granted by the Federal Internal Revenue Service for filing of the
Federal Income Tax Return.
Such request shall be filed with the City of Xenia, Income Tax Division, 101 N Detroit St., P O Box 490, Xenia OH
45385-0490 on or before the date the request is normally due. If your extension to file request is not approved,
the person filing this request will be notified by mail or email.
A copy of this application must be attached to the income tax return when filed.
INSTRUCTIONS
IMPORTANT - Show City account No., Social Security
No. and/or Federal I D No.
1. WHEN TO FILE – A taxpayer desiring an extension
of time for filing a City income tax return (Form R or R-
B) must submit an application on or before the due
date of the return.
Non-payment penalty of 5% per month (or
part thereof) will accrue on any tax due on
the return, from the regular due date of
the return until paid. Compounded
interest will accrue at the rate of 1.5% per
month (or part thereof) on any balance
due on the return, from the regular due
date of the return until paid. If less than
80% of the tax has been paid thru timely
estimate payments, a penalty for the
underpayment of estimated taxes may also
be charged in addition to the interest.
2. HOW AND WHERE TO FILE – Complete this form
forward to the City of Xenia, Division of Taxation, 101
N Detroit St., P O Box 490, Xenia OH 45385-0490. If
you wish to receive a copy of your approved
extension, an e-mail address or a self-addressed,
stamped envelope must be submitted with the form. If
your request is disapproved, the person filing this
request will be notified by mail. A copy of the
extension must be attached to your return when it
is filed.
3. REASONS FOR EXTENSION – The City of Xenia
will grant a reasonable extension of time for filing a
return if the taxpayer files a timely application.
4. SIGNATURE – Extension requests should be
signed by the individual taxpayer, an officer of a
corporation, a member of a partnership or the firm
employed to complete the annual return. When
submitting electronically, the form may be signed
digitally or an email address may be entered in lieu of
a signature.
5. BLANKET REQUESTS – Blanket requests for
extensions will be granted only if the list contains all
the pertinent information, especially SSN’s and
FID’s.
6. PERIOD OF EXTENSIONS – Generally, an
extension of time to file on an initial application will
follow the guidelines as set forth by the federal
government (IRS) – of 6 months. A longer period of
time will not be granted unless accompanied by a
Federal extension request, with a sufficient need for
such an extended period clearly shown.
UNDER NO CIRCUMSTANCES WILL AN EXTENSION BE GRANTED IF RECEIVED
AFTER THE DUE DATE.